Emergency ContraceptionWhen the unexpected happens

Canadians have many options to prevent pregnancy. From birth control pills, condoms and diaphragms to surgery, methods exist to suit each person’s lifestyle and preferences. However, sometimes a method of preventing pregnancy is not used, is forgotten, or fails. At these times, women in Canada may turn to pharmacists for assistance with emergency contraception.

Women and their partners have many birth control choices to prevent pregnancy. These options should be considered with the help of a doctor, pharmacist or other health care professional.

Canadians have many options to prevent pregnancy. From birth control pills, condoms and diaphragms to surgery, methods exist to suit each person’s lifestyle and preferences. However, sometimes a method of preventing pregnancy is not used, is forgotten, or fails. At these times, women in Canada may turn to pharmacists for assistance with emergency contraception.

In pharmacies in Canada, emergency contraception pills are available without a prescription. Also known as ‘the morning after pill,” this medication can be taken to prevent pregnancy after unprotected intercourse. It stops the release of an egg from the ovary, prevents fertilization, or prevents a fertilized egg from attaching to or implanting in the uterus (womb). This treatment will not end a pregnancy, and is not an abortion pill. It is a timely dose of a hormone that does not allow an egg to develop into a pregnancy. Emergency contraception has been shown to be a safe and effective method of preventing an unplanned pregnancy. It should not be used if a pregnancy has already been confirmed or abnormal vaginal bleeding has occurred.

Two products are available in Canada – plan B® and NorLevo®. Both contain two tablets of levonorgestrel, a medication often found in birth control pills. Levonorgestrel has been in use for many years. The tablets are taken together as a single dose. Generally they should be taken within 72 hours of unprotected sex to be most effective, but may be used for up to five days afterward.

Is emergency contraception an option?

Women need to know whether they can use emergency contraception to prevent an unplanned pregnancy. With the help of a pharmacist, a woman can determine if ‘the morning after pill’ is appropriate. The pharmacist will ask questions and assess information provided by the woman. Using a screening form developed by the Canadian Pharmacists Association, the pharmacist may ask the woman about the date of her last menstrual period and whether any other form of birth control was used. An explanation of how the medication works would be given, along with answers to any questions that arise. The www.planb.ca and www.norlevo.com websites can also help women to learn more and have an idea what to expect when taking the pills.

Side effects

The most common reported side effect of the pills is nausea. It happens in 14 to 23 per cent of women. Up to six per cent of women vomit. Some women may also have spotting or irregular menstrual bleeding until the next menstrual cycle. Others experience no ill effects at all. Occasionally, breast tenderness, headache, dizziness and diarrhea can occur. If these symptoms continue for more than 48 hours, consult a health care provider. If a woman develops itching or a rash, sudden stomach cramps or pain, or a severe headache, she should see a doctor right away. However, these situations are extremely rare. Most women tolerate the medication very well.

After the dose of levonorgestrel, women should expect their periods around the usual time. If the period is a week or more late, or more than three weeks pass without a period after taking the tablets, take a pregnancy test.

Preventing pregnancy

Emergency contraception should not be used as a regular form of birth control. While there are no medical restrictions on taking the pills more than once, they are only meant for emergency situations. A woman should consider a more long-term method of birth control if she does not want to become pregnant. Reserve the ‘morning after pill’ for emergencies or when a regular method of birth control fails. A health care provider can advise on an appropriate method to prevent unplanned pregnancy.

Condoms provide a physical barrier during sex, protecting against both pregnancy and sexually transmitted infections. While they are simple to use and readily available, failures using both male and female condoms do occur. Failure rates can be as high as 15 per cent. A diaphragm also provides a physical barrier to protect against pregnancy, but does not protect against infections. It must be fitted by a doctor.

Birth control pills (oral contraceptives) are a common choice for preventing pregnancy. These medications are highly effective and provide a reliable method of birth control that can be stopped or reversed at any time. Side effects are generally mild, especially with the newer low dose options available. Side effects include breast tenderness, nausea, headache and spotting. Women may choose to take the pills without any breaks. This extended or continuous dosing allows women to ‘skip’ periods. For women who have bad cramps or heavy bleeding, this is ideal. Birth control pills and other hormone treatments to prevent pregnancy do not protect against sexually transmitted infections.

Evra® is a birth control patch that gives medication through the skin. Patches are applied to the skin and left on for one week, for three weeks in a row. After that, the patch will be removed for one week. Some women have trouble keeping the patches on their skin, or have a skin reaction where the patch is applied.

NuvaRing®, another alternative to oral pills, is a ring containing hormones. It is placed inside the vagina for three weeks and then removed for one week. Both forms are very effective with few side effects. They are a reversible option for birth control.
Another option is a form of the hormone progesterone that is given by injection. Depo-Provera® is a long-lasting injection that provides three months of protection from pregnancy. It is given only four times per year. It contains no estrogen, and may result in no period. There may be a slight delay in return to fertility after stopping the injection. A few side effects, such as headache, weight gain and mood effects, are possible and should be considered.

A longer-lasting alternative is an IUD (intrauterine device). An IUD can be copper or hormonal (Mirena®). It is inserted into the uterus and can be left in place for up to five years. The effects will reverse when the device is removed. Some bleeding may occur after insertion, especially during the first month. Insertion must take place in a doctor’s office.

Women and their partners have many birth control choices to prevent pregnancy. These options should be considered with the help of a doctor, pharmacist or other health care professional. Many choices are available to suit individual lifestyles. If a long-term method of birth control fails (or is forgotten), emergency contraception is available. Both planB® and NorLevo® are available in pharmacies in Canada without a prescription. These products are very effective if used within 72 hours after unprotected sex. They can provide reassurance of pregnancy prevention. Pharmacists can help decide if emergency contraception is appropriate, and assist women in developing a plan for birth control.